Depression the Big-Ticket Item for Employers

While relationships between employee health risks and subsequent total health costs have shifted somewhat over time, depression still accounts for employers' highest per capita medical spending, a recent study showed.

Depressed employees -- making up roughly 11% of the work force -- spent on average $2,184, or about 48% more on healthcare than their nondepressed coworkers, a study published in the November issue of Health Affairs found.

Ron Goetzel, PhD, director of Emory University's Institute for Health and Productivity Studies, and colleagues examined the correlation between modifiable health risks and increased healthcare costs at seven organizations over 3 years.

They found that 22.4% of the annual health spending was linked to the 10 risk factors they studied. In addition to the higher costs for those with depression, employees with high blood sugar had health expenditures that were an average of 31.8% higher than those without it, while those with high blood pressure had 31.6% higher costs, and those with obesity had costs that were an average 27.4% higher, Goetzel and colleagues wrote.

On a federal level, provisions of the Affordable Care Act encourage employers to adopt health promotion and risk reduction programs, the authors noted. "An underlying premise of these provisions is that modifiable health risks, such as obesity and high blood pressure, are associated with increased health care costs in the employed population. Therefore, employers that undertake risk-reduction programs may save on healthcare expenditures."

The study aimed to provide an update to the 1998 Health Enhancement Research Organization study published in the Journal of Occupational and Environmental Medicine. Those data were collected from 1990 to 1995, and employer habits on worker wellness, as well as employee habits, have changed since then.

The Health Affairs study surveyed more than 92,400 employees. The employers administered health assessments through the MarketScan database from 2005 to 2009. Researchers adjusted for age, sex, health plan, location, industry type, and other factors.

Despite its high per-capita increased cost, depression accounted for nearly a third less spending ($11.9 million versus $32.1 million) than obesity. Overall, the 10 risk factors accounted for $82 million of the $366 million spent annually on healthcare by the seven employers.

Workers with high stress were found to have expenditures 8.6%, or $413, higher than nonstressed employees.

Tobacco users were 16.3% more costly ($587 in additional costs) than nontobacco users. Physically inactive employees were 15.3% more expensive ($606 in additional costs) than physically active workers. These workers comprised 21.5% and 36.4% of the surveyed employees, respectively.

However, not all of the studied risk factors correlated with higher health costs. High alcohol users were found to have 9.5% lower spending. "For alcohol, the findings suggest that the nationally recognized threshold for high risk (three drinks a day for men and two for women) may need to be revisited, because drinking at these levels would not constitute alcohol abuse," Goetzel and colleagues wrote. "There is also accumulating evidence that moderate alcohol consumption may be protective."

High cholesterol was linked to 2.5% lower health costs, and those with poor nutrition and eating habits had 5.2% less health spending. "This [latter] finding is likely because of the difficulty of determining the healthfulness of a person's diet, especially when nutrition habits are self-reported," the authors wrote.

Results of the current study were similar in many ways to the one from the 1990s. The spending impact was similar for 7 of the 10 risk factors. However, depression fell from accounting for 70.2% of higher health costs to 47.8%. High stress was the second highest risk factor in 1998 (46.4% more costly) and was seventh now.

"Carefully crafted, and effectively implemented, follow-up health promotion programs are needed if there is hope of achieving long-lasting behavior change and risk reduction among workers," Goetzel and others wrote.

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